Remuneration of doctors (general practitioners and specialists)
The remuneration of various categories of doctors affects the financial attractiveness of general practice and different specialties. Differences in remuneration levels of doctors across countries can also act as a “push” or “pull” factor when it comes to physician migration. In many countries, governments can determine or influence the level and structure of physician remuneration by regulating their fees or by setting salaries when doctors are employed in the public sector.
In all European countries, the remuneration of doctors (both GPs and specialists) is substantially higher than the average wage of all workers. In most countries, GPs earned two to four times more than the average wage in each country in 2020, while specialists earned two to five times more (Figure 7.12).
In most countries, specialists earned more than GPs, but the gap varies. In Belgium, self-employed specialists earned at least twice as much as self-employed GPs in 2020. In Germany, the difference between specialists and GPs is much smaller (about 20%).
In most countries, the remuneration of doctors has increased in real terms (adjusted for inflation) since 2010, but at different rates across countries and between GPs and specialists (Figure 7.13). The increase among both specialists and generalists has been particularly strong in Hungary. The Hungarian Government increased substantially the remuneration of specialists and generalists over the past decade to reduce the emigration of doctors and shortages.
In some countries, like Portugal, Slovenia and the United Kingdom, the remuneration of both GPs and specialists fell in real terms between 2010 and 2020. In Portugal, the reduction occurred between 2010 and 2012: since then, the remuneration of doctors has increased, but remained lower in 2020 than in 2010 in real terms. In the United Kingdom, the remuneration of doctors fell in real terms over the past decade as was also the case for nurses and other NHS staff (The Health Foundation, 2021[1]).
In several countries, the remuneration of specialists has gone up faster than that of generalists since 2010, thereby increasing the remuneration gap. However, in Austria, Belgium and the Netherlands, the gap has narrowed slightly, as the income of GPs grew more than that of specialists.
The remuneration of doctors refers to average gross annual income and normally excludes practice expenses for self-employed doctors (except in Belgium where practice expenses are included). A distinction is made between salaried and self-employed doctors, although in some countries this distinction is blurred as some salaried doctors are allowed to have a private practice and some self-employed doctors receive part of their remuneration through salaries. The OECD data also distinguish between GPs and all other specialists combined, although there can be wide differences in the income of different medical and surgical specialists.
A number of data limitations result in an underestimation of remuneration in some countries: 1) payments for overtime work, bonuses and other supplementary income are excluded in some countries (in Austria for GPs, and in Ireland and Italy for salaried specialists); 2) incomes from private practices for salaried doctors are not included in several countries (e.g. Czech Republic, Hungary, Iceland, Ireland and Slovenia); 3) data in several countries relate only to public sector employees who tend to earn less than those working in the private sector (Denmark, Greece, Hungary, Iceland, Ireland, Norway, the Slovak Republic and the United Kingdom); and 4) informal payments, which may be common in certain countries, are not included.
The income of doctors is compared to the average wage of full-time employees in all sectors in the country.
References
[1] The Health Foundation (2021), How has NHS staff pay changed over the past decade?, The Health Foundation, London, https://www.health.org.uk/news-and-comment/charts-and-infographics/how-has-nhs-staff-pay-changed-over-the-past-decade.
1. Practice expenses of self-employed GPs and specialists are included (resulting in an over-estimation). 2. Data for both salaried GPs and specialists are reported under salaried specialists as it is not possible to separate these two groups of doctors.
Source: OECD Health Statistics 2022.
